Warning Signs You May Need Foot or Ankle Surgery

Patients may develop arthritis or deformities in the foot or the ankle for many reason. Warning signs that you may be developing or have already developed significant arthritis in either your foot or ankle will include pain particularly with weightbearing or walking on an uneven ground, significant deformity to the foot or ankle, difficulty in wearing standard footwear, and decreased performance or increased discomfort during sporting activity.

Although there are numerous causes for all of the aforementioned symptoms and signs, they could be a sign that you have developed significant arthritis in the foot or ankle and it is best to consult with a specialist orthopedic surgeon who will take a full history and perform a physical examination as well as obtain plain film radiographs to determine possible diagnoses that may mean that you require foot and/or ankle surgery.

Who is a good candidate for Foot and Ankle Surgery?

Patients who have developed the aforementioned symptoms and have ideally tried (and subsequently failed) nonoperative treatment strategies such as footwear modification, orthotics or bracing, anti-inflammatory and other over-the-counter pain medications, injections of various types or physical therapy and periarticular strengthening.

Due to the complex nature of the anatomy of the foot and ankle, patients may experience some of the aforementioned symptoms but may not require any foot or ankle surgery at all. Conversely, patients may have more minor symptoms and still be good candidates for surgery.

In order to determine which category you fall into, your treating orthopedic surgeon will need to complete a full and complete history and physical examination and likely obtain special plain from radiographs and possibly even cross-sectional imaging in the form of CT or MRI scans.

Alternatives to Foot and Ankle Surgery

Although many patients who are good candidates for surgery do eventually end up requiring it, this is not the only option for treating numerous complaints within the foot and ankle and, as previously mentioned, there are a number of nonoperative modalities that can be trialed before reaching a point at which surgery is the only remaining effective option.

These include, but are certainly not limited to, physical therapy, over-the-counter analgesics and anti-inflammatories, footwear modification and/or orthotics, taping or bracing of the foot and ankle, intra-articular injections and even manual and massage therapy.

It is important to remember that while the most nonoperative treatment modalities will be at least partially effective for sometime, their effectiveness of any and all of these can diminish over time and patients may have to accept that surgery will be the best option for addressing their symptoms.

Ankle Surgery Procedure

Depending on the exact type and anatomical location of arthritis that the patient experiences, there are a number of different options for addressing this unique and often troublesome medical problem.

If the arthritis is confined to the tibiotalar joint, the patient may be considered a good candidate for a total ankle arthroplasty and although this procedure is still in its infancy, it is demonstrating some good results in early research studies. If the patient’s arthritis is predominantly in the subtalar joint then the patient will most likely be a good candidate for a subtalar fusion.

If the patient has arthritis in the subtalar and tibiotalar joints then fusion of a different type may be indicated and indeed if the patient has subtalar, tibiotalar, and talonavicular arthritis then the procedure of choice will be what is known as a triple fusion (fusing all three joints in the same procedure).

If you are unsure as to which type of arthritis you have and which is the most suitable procedure for you then consult with any of our orthopedic surgeons who will be able to guide you to the most appropriate procedure for your arthritis.

Foot Surgery Procedure

Foot surgery is quite a bit more complex than surgery in other areas of the body and as such there are a great deal of surgical procedures that a surgeon can choose from to perform depending on the exact nature of the presenting complaint.

For example, hallux valgus (more commonly known as bunions) can be treated in a number of different ways depending on the severity of the deformity and whether or not the metatarsophalangeal joint contains any arthritic change.

There are a great deal of different types of osteotomy that can be used to correct the bunion deformity and if arthritis is present then fusion at this joint is also a good option.

For more specific information and advice on your foot condition, we recommend that you speak to our specialist orthopedic surgeons who can assess you with a full history and physical examination as well as plain film radiographs and we will be happy to guide you through explanations of your diagnosis and the most appropriate surgical procedure for you.

Foot and Ankle Surgery Success Rates

It is important to maintain clear expectations of each surgery that one is considering having. For the most part, the goal of surgery is to improve pain, correct deformity or even in some cases both. Ultimately success rates for correcting deformity are quite high in foot and ankle surgery with the only major complication that may affect the success rate being recurrence of the deformity.

This complication rate is minimized by selecting the appropriate surgical procedure in appropriate patients and this will be explained in more detail by your surgeon.

Ankle surgery also has high success rates, however, a detailed discussion may be needed with patients should they prefer certain surgeries over others.

For example, if a patient is keen on pursuing a total ankle arthroplasty as opposed to an ankle fusion for the ankle arthritis, they must be willing to accept that there is a high rate of failure of this procedure in the medium term, and although the advantage to choosing ankle arthroplasty over fusion is maintenance of a good range of motion postoperatively, they may be facing repeated surgical procedures in their lifetime.

More detailed discussion surrounding the pros and cons of each surgical procedure can be had with your specialist orthopedic surgeon and we will be happy to explain success rates specific to each procedure to you in detail as well as the main signs of complications to watch out for postoperatively.

Foot and Ankle Surgery Risks and Complications

Although there are some surgical risks that are common to most procedures in the foot and ankle (for example, infection, neurovascular injury, and bleeding) each procedure carries its own set of specific potential complications that patients need to be made aware of.

For example, the most common complication in bunion surgery is recurrence of the bunion deformity after the surgery. Total ankle arthroplasty patients must be counseled with regards to the likelihood of aseptic loosening of the components around the 8 to 12-year mark. Fusion patients must be informed of the risk of nonunion, or failure of the fusion, in each specific type of fusion that exists.

Patient factors will also affect the potential risks and post-op complications – for example, infections post foot and ankle surgery are known to be a particular problem in certain types of patient population (e.g. diabetics, peripheral vascular disease patients) and it is important to remind patients of this when counseling them preoperatively for any types of surgery that they wish to undergo.

Recovery and Timeframe

Each surgical procedure in and around the foot & ankle has its own specific postoperative recovery protocol and as such each procedure comes with its own proposed time frame for recovery.

Given that the goal is slightly different in each case – for example, in total ankle arthroplasty patients can be weightbearing much sooner after the surgery than patients who undergo fusion procedures – these need to be stressed to each patient based on the surgery type and as such there is no “one size fits all” rule for every foot and ankle surgery patient.

Given the area around foot and ankle is one of the least well perfused areas in the body in terms of blood flow, infection is certainly an important complication to discuss with patients and every step should be taken to ensure that the risk of this is minimized.

Management of expectations is also very important particularly with fusion patients. Patients may feel they are not fully recovered given that they feel stiffness after the procedure and it should be stressed to them that the range of motion in the fused joints will decrease significantly (and, if the fusion is successful, ultimately be eliminated) and so feeling new areas of stiffness is normal and that the goal of surgery is not to improve or maintain the range of motion but specifically to relieve the pain.

Conclusion

There are a myriad of surgical procedures in the area of foot and ankle surgery and they are each appropriate for different patient populations and done for specific indications that are distinct from one another.

For guidance and information on your particular foot and ankle complaint, please contact our office and arrange to see one of our specialist orthopedic surgeons who will perform a full assessment and will be happy to discuss your diagnosis with you and answer any questions you may have, including the most appropriate management and which surgical procedures, if any, are most appropriate in your case.

Do you have more questions? 

How are foot and ankle injuries diagnosed?

Foot and ankle injuries are diagnosed through physical examination, medical history review, and often imaging tests such as X-rays, MRI scans, or CT scans to assess the extent of damage.

What are the treatment options for foot and ankle injuries?

Treatment options for foot and ankle injuries may include rest, ice therapy, compression, elevation (RICE protocol), immobilization with splints or casts, physical therapy, medications, and in severe cases, surgery.

Can foot and ankle injuries heal on their own without treatment?

Some mild foot and ankle injuries may improve with rest and conservative measures, but more severe injuries or conditions may require medical intervention to facilitate healing and prevent complications.

How long does it take to recover from a foot or ankle injury?

Recovery time from a foot or ankle injury varies depending on the type and severity of the injury, treatment approach, and individual factors, but it can range from weeks to months.

What are the potential complications of untreated foot and ankle injuries?

Potential complications of untreated foot and ankle injuries may include chronic pain, instability, decreased range of motion, joint stiffness, deformity, and increased risk of future injuries.

Can foot and ankle injuries lead to long-term joint damage or arthritis?

Yes, untreated or poorly managed foot and ankle injuries may contribute to long-term joint damage, degeneration, and the development of arthritis in the affected area.

Are there any preventive measures to reduce the risk of foot and ankle injuries?

Preventive measures for foot and ankle injuries may include wearing appropriate footwear, warming up before physical activity, using proper technique during sports or exercises, and maintaining strength and flexibility through regular exercise and stretching.

How does age and activity level influence the risk of foot and ankle injuries?

Age-related changes in bone density, muscle strength, and joint flexibility, as well as participation in high-impact activities or sports, can increase the risk of foot and ankle injuries.

What are the surgical options for treating severe foot and ankle injuries?

Surgical options for treating severe foot and ankle injuries may include fracture fixation, ligament reconstruction, tendon repair, joint fusion, joint replacement, and corrective osteotomy, depending on the nature of the injury and patient factors.

How effective are surgical interventions for foot and ankle injuries?

The effectiveness of surgical interventions for foot and ankle injuries depends on factors such as the type and severity of the injury, surgical technique, post-operative rehabilitation, and individual patient response.

What are the risks of foot and ankle surgery?

Risks of foot and ankle surgery may include infection, bleeding, nerve or blood vessel injury, anesthesia complications, stiffness, weakness, nonunion or malunion of bones, and failure to achieve desired outcomes.

Can foot and ankle injuries lead to chronic pain or disability?

Yes, severe or improperly managed foot and ankle injuries can result in chronic pain, functional limitations, and disability that may impact daily activities and quality of life.

How can individuals prevent overuse injuries in the foot and ankle?

Preventive measures for overuse injuries in the foot and ankle may include gradually increasing activity levels, incorporating rest days into training routines, cross-training to reduce repetitive stress on specific structures, and maintaining proper biomechanics.

What are the risk factors for developing foot and ankle injuries?

Risk factors for foot and ankle injuries include previous injuries, structural abnormalities, improper footwear, sudden changes in activity level or intensity, and participation in high-impact sports or activities.

Can foot and ankle injuries affect mobility and balance?

Yes, foot and ankle injuries can affect mobility and balance by causing pain, weakness, instability, or altered biomechanics that may interfere with walking, running, or standing.

How can foot and ankle injuries impact sports performance?

Foot and ankle injuries can impact sports performance by limiting movement, agility, speed, and power generation, and may require modifications to training or playing techniques to accommodate for limitations.

Are there any specific exercises or rehabilitation protocols for recovering from foot and ankle injuries?

Yes, physical therapy programs tailored to the specific injury or condition can help improve strength, flexibility, balance, and proprioception, facilitating a safe return to activity and reducing the risk of recurrent injuries.

Can foot and ankle injuries lead to complications during pregnancy or childbirth?

While foot and ankle injuries themselves do not typically lead to complications during pregnancy or childbirth, existing injuries or structural abnormalities may be exacerbated by weight gain and hormonal changes, requiring special considerations in management.

How can individuals with foot and ankle injuries maintain fitness levels during recovery?

Individuals with foot and ankle injuries can maintain fitness levels during recovery by engaging in low-impact activities such as swimming, cycling, or upper body strength training, as approved by their healthcare provider.

Dr Vedant Vaksha

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.